Georgia Form 500 - Individual Income Tax Return - 2011 Page 3

Download a blank fillable Georgia Form 500 - Individual Income Tax Return - 2011 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Georgia Form 500 - Individual Income Tax Return - 2011 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Page

500

Georgia Form

Individual Income Tax Return

Georgia Department of Revenue

2011

YOUR SOCIAL SECURITY NUMBER

Version 1

21.

Department Use Only

DO NOT WRITE IN THIS BOX

22.

Total prepayment credits (Add Lines 19 and 20 )..........................................

22.

23.

If Line 18 exceeds Line 22 enter BALANCE DUE STATE...................................

23.

24.

If Line 22 exceeds Line 18 enter OVERPAYMENT amount................................

24.

25.

Amount to be credited to 2012 ESTIMATED TAX .....................................

25.

26.

Georgia Wildlife Conservation Fund (No gift of less than $1.00)...................

27.

Georgia Children and Elderly Fund (No gift of less than $1.00).....................

27.

28.

Georgia Cancer Research Fund (No gift of less than $1.00) .......................

Statewide Land Conservation Program (No gift of less than $1.00) ............

29.

30.

Georgia National Guard Foundation (No gift of less than $1.00) ..................

30.

31.

Dog & Cat Sterilization Fund (No gift of less than $1.00) ...........................

31.

32.

Save the Cure Fund (No gift of less than $1.00).........................................

Georgia Student Finance Authority Fund (No gift of less than $1.00).........

33.

34.

Form 500 UET (Estimated tax penalty)..........................................................

34.

(If you owe) Add Lines 23, 26 thru 34

35.

MAKE CHECK PAYABLE TO GEORGIA DEPARTMENT OF REVENUE

............

35.

36.

Subtract the sum of Lines 25 thru 34 from Line 24

(If you are due a refund)

.............................................................

THIS IS YOUR REFUND

36.

GEORGIA DEPARTMENT OF REVENUE

(PAYMENT and NO

36b.

36a.

SEND REFUNDS TO:

Direct Deposit

Debit Card

(For U.S. Accounts Only)

Type:

Checking

Savings

PROCESSING CENTER, PO BOX 740399

BALANCE DUE)

2D 500 and 500EZ (Refunds)

ATLANTA, GA 30374-0399

Routing

See booklet instructions

36c.

Paper Check

Number

Georgia Dept. of Revenue

on page 13 for

(REFUND)

GEORGIA DEPARTMENT OF REVENUE

further details.

P.O. Box 105597

PROCESSING CENTER, PO BOX 740380

Account

ATLANTA, GA 30374-0380

Atlanta, Georgia 30348-5597

Number

ENCLOSE ALL ITEMS IN RETURN ENVELOPE. DO NOT STAPLE YOUR CHECK, W-2’S OR TAX RETURN

Georgia Public Revenue Code Section 48-2-31 stipulates that taxes shall be paid in lawful money of the United States, free of any expense to the State of GA

Under penalty of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and

belief it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which the preparer has knowledge.

PHONE NUMBER

Taxpayer’s Signature

(Check box if deceased)

DATE

Spouse’s Signature

(Check box if deceased)

DATE

NAME OF PREPARER OTHER THAN TAXPAYER

Do you want to authorize DOR to discuss this return with the

named preparer.

YES

PREPARER’S FEIN